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KCC Registration Form
Please share the information listed below. Thank you!
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Grade *
Parent's Name *
Your answer
Parent's Email Address *
Your answer
Parent's Work Phone *
Your answer
Parent's Cell Phone Number *
Your answer
Second Parent's Name (if available)
Your answer
Second Parent's Work Phone Number
Your answer
Second Parent's Cell Phone
Your answer
Second Parent's Email Address
Your answer
Other Emergency Names and Phone Numbers (we might need)
Your answer
Please sign my child up for the following sessions: *
Required
Payment Options *
Required
I understand that I need to have a set schedule for my child or need to respond to the weekly KCC email about my child's attendance. (Please initial.) *
Your answer
Please list any health concerns. The nurse's office is not open during KCC hours. *
Your answer
The following people are authorized to pick up my child. (Please list names and phone numbers.) *
Your answer
My child has my permission to walk home. *
Parent/Guardian Signature (please type) *
Your answer
Date *
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